Willingness to pay for one quality-adjusted life year in Iran

Abstract

Background Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society’s preferences. Methods A cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents’ willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people’s quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model. Results WTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US$1032 to US$2666 and 0.22–0.56 of Iran’s local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY. Conclusion From the general public’s perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts. Electronic supplementary material The online version of this article (10.1186/s12962-019-0172-9) contains supplementary material, which is available to authorized users.

An exploratory study to estimate cost-effectiveness threshold value for life saving treatments in western Iran

“…The amount that the participants were willing to pay for the additional QALY gained from the life-saving treatment for a family member was about US$ 1,355, which represent 0.27 of the GDP per capita. These values are slightly lower than the WTP values of 0.22 to 0.56, and 0.57 of the GDP per capita for the additional QALY gained ndings reported from studies in Iran (2,30). Comparatively speaking other countries such as Thailand found the WTP value of 1.42 times the GDP per capita for the additional QALY gained from life-saving interventions (4).…”

An exploratory study to estimate cost-effectiveness threshold value for life saving treatments in western Iran

“…The amount that the participants were WTP for the additional QALY gained from the life-saving treatment for a family member was about US$ 1,355, which is about 0.27 of the GDP per capita. These values are slightly lower than the WTP values of 0.22 to 0.56, and 0.57 of the GDP per capita for the additional QALY gained ndings reported from studies in Iran (2,29). However, others from Thailand found the WTP value of 1.42 times the GDP per capita for the additional QALY gained from life-saving interventions (4).…”

“…However, a study in Tehran reported an average WTP per QALY of the participants ranging from US$ 1,032 to US$ 2,666. These minimum and maximum values accounted for 0.22 to 0.56 GDP per capita of Iran in 2014 (2).…”

“…The scarcity of healthcare resources and the increasing clients' treatment demands challenge the decisions on resource allocation such as nancial reimbursements, especially in the health systems of resource-constrained countries (1,2). The incremental cost-effectiveness ratio (ICER) can be applied to compare the costs and health gains from two or more alternative interventions and is a widely used to handle challenging decisions (3)(4)(5).…”

An exploratory study to estimate cost-effectiveness threshold value for life saving treatments in western Iran

“…The scarcity of healthcare resources and the increasing clients' treatment demands challenge the decisions on resource allocation including financial reimbursements, especially in the health systems of the resource-constrained countries (1,2). The cost-effectiveness analysis which compares the costs and health gains from two or more alternative interventions in terms of the incremental cost-effectiveness ratio (ICER), is widely used to handle such challenging decisions (3)(4)(5).…”